Sriwijaya Journal of Ophthalmology

Epiretinal Membrane Management for Young Adult Patient: A Case Report

Avizena Muhammad Zamzam — 2024-01-19

Introduction: Epiretinal membrane (ERM) is a condition where a thin fibrotic tissue layer appears on the surface of the macula, which causes a decrease in visual acuity. There are still limited data about the management of ERM due to its low incidence. We reported a case of epiretinal membranes in young adult patients.

Case presentation: A 40-year-old male complained of blurry vision on the left eye since 6 months ago. His visual acuity was reduced, and a fundus photograph and macula OCT examination were performed. He was diagnosed with left eye epiretinal membrane and planned for left eye membrane peeling. The retinal break was found intraoperatively as a suspected predisposing factor.

Conclusion: Management of severe ERM focuses on reducing metamorphopsia, improving visual acuity, and improving binocularity with pars plana vitrectomy combined with membrane peeling. At a young age, the predisposing factors for secondary development must be further identified.

A 39-Year-Old Woman with Oculodermal Melanocytosis: A Case Report

Gina Sonia Fensilia Yolanda — 2024-01-22

Introduction: Nevus of Ota, also known as oculodermal melanocytosis (ODM), is characterized by macular pigmentation which localized to the forehead and periocular area. It usually shows a dermatomal distribution from the first two branches of the trigeminal nerve. We reported a case of oculodermal melanocytosis (ODM).

Case presentation: A 39-year-old woman, came with complaints of her left eye rolling inwards for the past 5 years accompanied by a flat black spot on her forehead that spread to her left cheek. She was done macular OCT and orbital ultrasonography of the left eye. She was diagnosed with oculodermal melanocytosis in the left eye, moderate NPDR in both eyes, juvenile cataracts in both eyes, and esotropia in the left eye due to left-eye cranial nerve VI paralysis. Follow-up at 6 months was advised to the patient.

Conclusion: Although this is a benign condition, patients are at risk of developing complications such as increased intraocular pressure and melanoma of the skin and/or uvea, ongoing evaluation with imaging methods is highly recommended even if only skin lesions may be repaired using laser for cosmetic reasons.

Management of Wet Age-Related Macular Degeneration: A Case Report

Retno Tharra Handayani — 2024-02-12

Introduction: Age-related macular degeneration (AMD) is a progressive neurodegenerative disease of the photoreceptors and retinal pigment epithelium (RPE). It is a leading cause of blindness and visual impairment in the elderly population, despite recent advances in treatment. We reported a case of wet AMD and its management.

Case Presentation: A 69 years old woman complained of blurred vision, especially in the left eye, which she had experienced since 3 years ago, progressively worsen since the last 3 months. Fundoscopy and OCT examination was done. Fundoscopy found no foveal reflex with a drusen and perifoveal haemorrhage found on left eye. She was diagnosed with wet age-related macular degeneration type II of left eye. She had done intravitreal anti-VEGF injection with local anaesthesia.

Conclusion: AMD management relies heavily on observation, lifestyle changes, frequent follow-up evaluations, early recognition of visual impairment and detection of CNV. Meanwhile, the current modality for wet AMD therapy is intravitreal anti-VEGF injection to preserve patient’s visual acuity and improve quality of life.

Prevalence and Analysis of Risk Factors for Cataracts in Jember Regency, Indonesia

Siti Rohmah — 2024-03-03

Introduction: Cataracts are the leading cause of preventable blindness. This study aims to determine the prevalence of cataracts and analyze the risk factors for cataracts in Jember Regency.

Methods: The research design is observational research with a cross-sectional approach. The study carried out eye examinations on 1000 adults (≥50 years) who were randomly selected in Jember Regency. Risk factors analyzed included age, gender, education, occupation, smoking, and history of diabetes mellitus and hypertension.

Results: The prevalence of cataracts in Jember Regency is 25.3%. Risk factors associated with the incidence of cataracts are age (OR=1.35; 95%CI: 1.02-1.98), female gender (OR=1.54; 95%CI: 1.12-2.13), low education (OR=1.83; 95%CI: 1.22-2.73), outdoor work (OR=3.72; 95%CI: 1.14-5.58), smoking (OR=1.42; 95%CI: 1.01-2.00), and history of diabetes mellitus (OR=2.15; 95%CI: 1.43-3.24).

Conclusion: The prevalence of cataracts at ages ≥ 50 years in Jember Regency is quite high. Age, female gender, low education, outdoor work, smoking, and a history of diabetes mellitus are risk factors for cataracts.

Impact of COVID-19 on Preventable Blindness Detection in Bali, Indonesia

Ni Putu Dharmi Lestari — 2024-04-19

Introduction: WHO, and the Indonesian government, have agreed to a plan to eradicate preventable blindness by 2020 in VISION 2020. However, the COVID-19 pandemic has caused a strain on the healthcare system. It is difficult to assess the impact of the pandemic on preventable blindness. Here we approach the issue by evaluating hospital visits for visual impairments in one regency in Bali, Indonesia.

Methods: We collected outpatient visit records from three hospitals providing ophthalmologic clinics in Tabanan, Bali, Indonesia, a regency of 445 thousand people. We then conducted a descriptive analysis of the general changes in outpatient visits to these clinics and changes observed in different diagnoses identified as causes for preventable blindness.

Results: The result showed a 35% downtrend in outpatient visits to the ophthalmologic clinic throughout the provinces. A more pronounced downtrend (45.22%) was observed for one public hospital that also serves as a COVID-19 referral hospital compared to private hospitals (around 30% each). By diagnoses, visits for cataracts were shown with a less severe downtrend compared to glaucoma, pterygium, and refractive disorders.

Conclusion: Our study found a downtrend in outpatient visits for visual impairment in ophthalmologic clinics, which may be attributed to COVID-19 preventive measures by the hospital as well as patient reluctance due to fear of COVID-19 transmission. Public health communication needs to address this fear to recover patient confidence while maintaining vigilance in practicing COVID-19 preventive behavior.

An Investigation of Keratoplasty Procedures and Their Outcomes in Iraq

Rafid Hameed Leki — 2024-04-23

Introduction: The treatment of corneal disorders involves the use of various forms of keratoplasty. The objective of this study was to provide a detailed description of the various types of keratoplasty procedures performed in Iraq, as well as their corresponding outcomes.

Methods: An observational study was conducted at Al-Zahraa Teaching Hospital to document cases of keratoplasty. The collected data included age, gender, types of keratoplasty, indications, previous surgical or medical history, and postoperative outcomes. The types of keratoplasty included penetrating keratoplasty (PKP), deep anterior lamellar keratoplasty (DALK), and Descemet's stripping endothelial keratoplasty (DSEK). Additionally, we performed cataract surgery and intraocular lens (IOL) insertion for those with cataracts, using either IOLs with scleral fixation or IOLs with iris fixation. We complete the task on the first day following the purchase order, then the first week, the first month, and every six months thereafter. Prior to surgery, patients with corneal vascularization had laser photocoagulation of the blood vessels in the cornea.

Results: Ages range from 4 to 90. People over 40 (60.8%) were the most common age group. The female prevalence was 52.9%. Right-eye illness was diagnosed 51.6% of the time. 60% of patients underwent PKP. 26.8% had DALK, 12.4% had DSEK. Post keratoplasty, the statistically-significant improvement-ratio was 68.5% as eyes best corrected visual acuity (BCVA) improvement, while 12.2% of eyes showed a decline in BCVA and 19.3% discharged with no changes in BCVA. Postoperatively, BCVA was significantly lower in cases with a duration below 1 year (1.5), and better among the duration > 3 years (0.5). The greatest improvements were seen in cases with infective keratitis (-0.7), corneal dystrophies (-0.6), and advanced keratoconus (-0.7) whereas the lowest rates were documented in cases with a graft rejection (-0.3), and bullous keratopathy (-0.3)

Conclusion: Keratoplasty is associated with a substantial enhancement of visual acuity in the younger population. Infective keratitis, keratoconus, and corneal dystrophy produce the most optimal and superior results. The PKP method is the most frequently performed.